Morbidity Rates Research Articles

Calculation of Life Insurance Premiums with Markov Chain Applications for Patients with Pulmonary Tuberculosis Disease in Indonesia

This study aims to calculate the premium for Long Term Care (LTC) insurance on Annuity as A Rider Benefit products with a multi-status model. Pulmonary Tuberculosis is one of the major infectious diseases that contribute significantly to morbidity and mortality rates. Therefore, it is necessary to calculate insurance premiums that consider the health risks of sufferers. In this study, Markov chains are used to model the health status transition of individuals with Pulmonary Tuberculosis over time, considering several health states, such as healthy, sick, and dead. Tuberculosis epidemiological data in Indonesia is used to estimate the transition probabilities between health states. The case study used in this research is a 35-year-old man who participates in LTC insurance with a coverage period of 5 years. It is known that the value of compensation when a person dies is IDR 100,000,000. The interest rate used is 5%. The calculation results obtained annual premium for LTC insurance on Annuity as A Rider Benefit product is Rp294,333. Then the calculation of the annual net premium of this insurance is also calculated based on age and gender. When age increases, the premium will be greater, this is influenced by the greater chance of death when age increases. In addition, based on gender, it is found that the male premium is more expensive than the female gender. This is influenced by the chance of death of men is greater than women.

Understanding Natural Immunity against Malaria: Mechanisms, Implications, and Future Directions

Malaria remains a significant global health challenge, particularly in sub-Saharan Africa, where it contributes to high morbidity and mortality rates. Natural immunity to malaria, acquired through repeated exposure to Plasmodium parasites, provides partial protection against severe disease but does not prevent infection. This review explores the mechanisms underlying natural immunity, including the roles of innate and adaptive immune responses, and the impact of factors such as age, genetics, and repeated exposure. It also examines the implications of natural immunity for malaria control strategies, particularly in endemic regions where partial immunity helps reduce the disease burden. The review highlights recent advances in immunological research, including the identification of immune markers and biomarkers that correlate with malaria resistance. Additionally, it discusses how natural immunity can inform the development of more effective vaccines and therapies. The review concludes by identifying key gaps in current research and suggesting future directions, including enhancing natural immunity through vaccines and immunotherapies, and the importance of global collaboration in advancing malaria control efforts. Keywords: Malaria, Natural immunity, Innate immunity, Adaptive immunity, Plasmodium parasites, Vaccine development.

МНОГОЛЕТНИЕ ЭПИДЕМИОЛОГИЧЕСКИЕ ТРЕНДЫ ДИНАМИКИ АЛЛЕРГИЧЕСКОГО РИНИТА И АТОПИЧЕСКОГО ДЕРМАТИТА У ДЕТЕЙ

Background. Allergic rhinitis and atopic dermatitis are common allergic diseases in children. Analysis of the incidence and trends of allergic diseases development is necessary for successful solving the problem of morbidity, helping the child population at the regional level, disease forecasting and control. Purpose of the study. To study the long-term dynamics of the main epidemiological indicators of the general and primary incidence of allergic rhinitis and atopic dermatitis in the child population of the Grodno region. Material and methods. Retrospective analysis of indicators of general and primary incidence of allergic rhinitis and atopic dermatitis in the child population of the Grodno region was performed. The study periods were 1999-2023 years (children aged 0-14 years old) and 2008-2023 years (children aged 15-17 years old). Results. The average long-term age-standardized overall morbidity rate of allergic rhinitis in children aged 0-14 years old was 266.89 (95% CI: 238.33-295.47), the primary morbidity rate was 67.67 (95% CI: 57.36-77.9) per 100,000 children of the corresponding age. The average long-term overall incidence rate of allergic rhinitis in children aged 15-17 years (2008-2023) was 791.97 (95% CI: 680.79-903.14), the primary incidence rate was 113.73 (95% CI: 92.84- 134.61) per 100,000 children of the same age. The average long-term age-standardized rate of overall incidence of atopic dermatitis in children aged 0-14 years old was 872.89 (95% CI: 825.27-919.782) per 100,000 children of the corresponding age, the primary incidence rate was 459.1 (95% CI: 399. 96-518.24) per 100,000 children of the same age. The average long-term overall incidence rate of atopic dermatitis in children aged 15-17 years was 415.68 (95% CI: 377.63-453.73), the primary incidence rate was 143.88 (95% CI: 120.53-167.23) per 100,000 child population of the corresponding age. The long-term epidemic dynamics of allergic rhinitis was characterized by a moderately pronounced tendency towards an increase in the overall incidence rate among children aged 0-14 years old (average growth (decrease) rate = +2.4%) and 15-17 years old (average growth (decrease) rate = +3.62 %) as well as stabilization of the primary morbidity rate in children aged 0-14 years old (average growth (decrease) rate = -0.67%) and 15-17 years old (average growth (decrease) rate = +0.72%). The long-term epidemic dynamics of atopic dermatitis was characterized by a moderately pronounced tendency towards a decrease in the overall morbidity rate for children aged 0-14 years old (average growth (decrease) rate = -1.57%) and an increase in the morbidity rate for children of 15-17 years old (average growth (decrease) rate = +2.1%). There also was a pronounced downward trend in the primary morbidity rate of children aged 0-14 years old (average growth (decrease) rate = -5.42%) and children aged 15-17 years old (average growth (decrease) rate = -5.89%). The cartograms of the territorial distribution of incidence rates of allergic rhinitis and atopic dermatitis in the child population of the Grodno region in the periods 1999-2023 (0-14 years old) and 2008-2023 (15-17 years old) are presented. Conclusions. The reasons for the established patterns of changes in the incidence of allergic diseases in children of different age groups, as well as those living in different territories, are most likely due to the influence of environmental and socio-economic factors. The presented cartograms make it possible to visualize the incidence rates of allergic rhinitis and atopic dermatitis in individual territorial and administrative regions of the region.

Surgical Outcome in Retroperitoneal Sarcoma Surgery: Accuracy of P-POSSUM, ACS-NSQIP, and Inflammatory Biomarkers Prognostic Index (IBPI) Risk-Calculators for Prediction of Severe and Overall Morbidity.

Retroperitoneal sarcoma often requires comprehensive resection, leading to severe postoperative morbidity. The lack of disease-procedure specific tools for morbidity risk and the questionable accuracy of existing tools (ACS-NSQIP and P-POSSUM) in RPS surgery drove this study to assess these calculators' accuracy. Retrospective analysis of primary RPS cases undergoing surgery at two sarcoma-referral centers was conducted. Predicted morbidity/mortality rates at 90days postsurgery, classified by Clavien-Dindo (CD) and Comprehensive Complication Index (CCI), were compared with observed data. Accuracy was assessed by Brier Score and area under the curve (AUC). Inflammatory Biomarkers Prognostic Index (IBPI) also was tested. A total of 567 patients (median age 62years; 53.6% male) with a median of four resected organs were included. 59% experienced surgical complications by 90 days postoperation, graded CD ≥ 3 in 30.5%, median CCI 20.9, with a mortality rate of 1.6% (8/567). Reoperation was required in 68 of 567 patients (12%). Thirty-day mortality was 1.1%. Severe complications occurred after 30th postoperative day in 3.5% cases. ACS-NSQIP predicted below-average complication for 65.1%, average for 16.9%, and above-average for 18% of patients. P-POSSUM predicted a 66% rate of morbidity and 4% mortality. None of the prediction tools were accurate, with Brier scores ranging 0.155-0.231 and no AUC ≥ 0.7. IBPI accuracy for predicting severe infective complication was low (AUC 0.58, Brier 0.161). The significant morbidity burden after MVR necessitates reliable evaluation, especially in frail patients. Given the limitations of ACS-NSQIP and P-POSSUM, a dedicated prediction tool for perioperative events in RPS candidates for MVR needs urgent development.

Does Functional Status Predict Worse 30-D Outcomes in Endovascular Repair of Abdominal Aortic Aneurysms? A Propensity-Score Matched Study From ACS-NSQIP Targeted Database From 2012 to 2022

IntroductionIn patients undergoing endovascular aneurysm repair (EVAR), existing studies have identified an association between dependent functional status (DFS) and poorer outcomes after EVAR. However, noted limitations, especially the lack of differentiation between ruptured and nonruptured abdominal aortic aneurysm (AAA), potentially affect the extrapolation of these findings to specific patient groups. Thus, this study aimed to evaluate the association between functional status and 30-d outcomes after EVAR in ruptured and nonruptured AAA patients separately. MethodsPatients who underwent infrarenal EVAR were identified in the American College of Surgeons National Surgical Quality Improvement Program targeted database from 2012-2022. Patients with DFS and those with independent functional status (IFS) were stratified into the two study cohorts. In nonruptured AAA, a 1:1 propensity-score matching was used to address demographics, baseline characteristics, aneurysm diameter, distal extent of the aneurysm, anesthesia, and concomitant procedures between patients with DFS and IFS. The sample size for ruptured patients with AAA was too small for meaningful statistical analysis so only qualitative description was provided. Thirty-d postoperative mortality and morbidities of EVAR were assessed. ResultsFor nonruptured cases, there were 380 (2.55%) DFS and 14,545 (97.45%) patients with IFS, where 453 patients with IFS were matched to the DFS cohort. For ruptured AAA, there were 17 (6.39%) DFS and 249 (93.61%) IFS. After matching, nonruptured DFS and patients with IFS had similar 30-d mortality rates (2.37% vs 2.11%, P = 1.00). However, patients with DFS had a higher risk of bleeding requiring transfusion (18.42% vs 11.84%, P = 0.01) and longer length of stay (median 3.00 [Q1 1.00, Q3 6.00] vs median 2.00 [Q1 1.00, Q3 4.00] d, P < 0.01). All other outcomes, including major adverse cardiovascular events, cardiac complications, stroke, pulmonary complications, renal complications, sepsis, venous thromboembolism, wound complications, lower extremity ischemia, ischemic colitis, postoperative ruptured aneurysm, unplanned reoperation, 30-d readmission, were not different between patients with DFS and IFS. Qualitatively, ruptured patients with DFS had higher crude rates of 30-d mortality and morbidities compared to patients with IFS. ConclusionsContrary to previous literature, patients with DFS with nonruptured AAA undergoing EVAR were found to have largely comparable outcomes to patients with IFS, although extra attention should be paid to postoperative bleeding.

Randomized Controlled Study Comparing Hamstring Graft and Peroneus Longus Tendon Graft in Arthroscopic ACL Reconstruction.

Graft choice for anterior cruciate ligament reconstruction (ACLR) has been evolving. The peroneus longus tendon (PLT) has been seen as a suitable choice for ACLR, providing comparable results to those of hamstring tendon (HT) autograft, but its clinical relevance in terms of return to sports, to our knowledge, has not been studied. One hundred and twenty patients who sustained an isolated ACL injury were enrolled and underwent ACLR using tripled or quadrupled PLT autograft (if graft thickness exceeded 10 mm then tripled) or quadrupled HT autograft. Patients were followed for 24 months. Functional scores (International Knee Documentation Committee [IKDC] and Tegner-Lysholm scores) were assessed preoperatively and at 3, 6, 12, and 24-month post-operatively. Graft diameter and graft harvesting time were measured intraoperatively. Donor-site morbidity was evaluated using subjective evaluation. Time to return to sports in both groups was compared. The mean diameter of the PLT autograft was significantly larger than that of the HT autograft, and the mean graft harvesting time was less (P < 0.001). Patients in the PLT group returned to sports a mean of 36 days earlier than those in the HT group (P < 0.001) and had a lower rate of donor-site morbidity, and better patient-reported outcomes at the knee (P < 0.001). There was a significant difference between the groups in IKDC and Tegner-Lysholm scores at the 24-month follow-up. Despite some donor site complications, such as numbness and infection, both PLT and HT grafts offer acceptable knee stability. However, PLT grafts seem to provide superior subjective functional outcomes based on patient-reported scores. More research is needed to further establish these findings and optimize graft choices for individual patients.

Aerobic bacteria study, clinical spectrum, and outcome of patients with community-acquired multidrug-resistant pathogens

ABSTRACT Context: Infectious diseases are the leading cause of death in developing countries like India. Hence, even small relative increases in the mortality rate for infections due to multidrug-resistant pathogens would lead to substantial increases in the number of deaths as a result of infections worldwide. Aims: The aim of the study was to study the microbiological data of community-acquired pathogens and the corresponding outcomes due to antibiotic-resistant versus antibiotic-susceptible bacterial microorganisms. Settings and Design: A single-center prospective cohort study for two years undertaken during the study period of March 2022 to 31 October 2023. Materials and Methods: All clinical samples of 402 patients diagnosed microbiologically as community-acquired infections were included. Culture samples were collected and processed according to standard operating procedures and clinical details were recorded. Statistical Analysis Used: Categorical variables were expressed as counts and percentages. Fisher’s exact test was used for testing differences in proportions. Two-sided distribution P values of &lt;0.05 were considered significant. Results: Among Gram-positive organisms, Staphylococcus aureus and Streptococcus pyogenes were predominant isolates. Escherichia coli and Klebsiella species were the majority of the pathogens among Gram-negative isolates. Mortality rates observed in community-acquired respiratory tract infections (CA-RTIs), community-acquired urinary tract infections (CA-UTIs), community-acquired skin and soft tissue infections (CA-SSTIs), and community-acquired bloodstream infections (CA-BSIs) were 13.6%, 6.56%, 4.5%, and 31.5%, respectively. The length of hospital stay of more than three days was found as 56.06%, 36.2%, 40.9%, and 73.6% in CA-RTIs, CA-UTIs, CA-SSTIs, and CA-BSIs, respectively. Conclusions: Performing cultures earlier during hospitalization and determining the timing of colonization can allow more targeted choices and reduce morbidity and mortality rates among infected patients.

Targeting Macrophage Phenotype for Treating Heart Failure: A New Approach.

Heart failure (HF) is a disease with high morbidity and mortality rates worldwide and significantly affects human health. Currently, the treatment options for HF are limited, and there is an urgent need to discover new therapeutic targets and strategies. Macrophages are innate immune cells involved in the development of HF. They play a crucial role in maintaining cardiac homeostasis and regulating cardiac stress. Recently, macrophages have received increasing attention as potential targets for treating HF. With the improvement of technological means, the study of macrophages in HF has made great progress. This article discusses the biological functions of macrophage phagocytosis, immune response, and tissue repair. The polarization, pyroptosis, autophagy, and apoptosis are of macrophages, deeply involved in the pathogenesis of HF. Modulation of the phenotypic changes of macrophages can improve immune-inflammation, myocardial fibrosis, energy metabolism, apoptosis, and angiogenesis in HF.

Hepatitis B virus infection among hemodialysis patients in Aden-Yemen

HBV infection is one of major global health problems worldwide. It increases the morbidity and mortality rates among hemodialysis patients which make the management process more complicated. This study was aimed to determine the prevalence of HBV infection among hemodialysis patients and assessment the risk factors associated with infection. An analytical cross-sectional study was conducted on 50 HD patients. Blood samples were collected and serum HBsAg was analyzed using ELISA technique. The overall prevalence of HBV was 6 (12.0%). The males had highest rate. There were statistically significant recorded between the prevalence of HBV infection and age group 30 – 39 years and duration of hemodialysis from 1-2 years and more than 2 years (p=0.02, 0.001 and 0.001) respectively. It can be concluded that the HBV prevalent rate among HD patients was common and lower than that reported among most general population in Yemen. Increasing of the duration and long standing in hemodialysis unit may increase the risk of HBV infection. Hepatitis B vaccine should be given to all HBV negative HD patients before HD process and health education programs about the transmission routes of HBV and preventive measures should be implemented for general population.

Rescue of COVID-19 Patient Complicated by Spontaneous Pneumothorax and Acute Pulmonary Thromboembolism

Abstract Pulmonary thromboembolism is a common cardiovascular disease, with high morbidity and mortality rates in hospitalized patients. Because of clotting disorders and hypoxemia caused by COVID-19, critically ill patients are highly susceptible to thrombotic complications. A study published in the Journal of the American Medical Association in 2022 showed that the incidence of venous thromboembolism (VTE) in critically ill COVID-19 patients was approximately 10% to 35%, whereas the incidence of VTE in autopsy cases was as high as 60% (JAMA Intern Med 182:1063-1070). Clinicians need increased awareness of VTE in COVID-19 patients, to reduce the risk of deep vein thrombosis and pulmonary thromboembolism and to be alert to life-threatening complications.

Application of Nanoparticles in the Diagnosis and Treatment of Colorectal Cancer.

Colorectal cancer is a common malignant tumor with high morbidity and mortality rates, imposing a huge burden on both patients and the healthcare system. Traditional treatments such as surgery, chemotherapy and radiotherapy have limitations, so finding more effective diagnostic and therapeutic tools is critical to improving the survival and quality of life of colorectal cancer patients. While current tumor targeting research mainly focuses on exploring the function and mechanism of molecular targets and screening for excellent drug targets, it is crucial to test the efficacy and mechanism of tumor cell therapy that targets these molecular targets. Selecting the appropriate drug carrier is a key step in effectively targeting tumor cells. In recent years, nanoparticles have gained significant interest as gene carriers in the field of colorectal cancer diagnosis and treatment due to their low toxicity and high protective properties. Nanoparticles, synthesized from natural or polymeric materials, are NM-sized particles that offer advantages such as low toxicity, slow release, and protection of target genes during delivery. By modifying nanoparticles, they can be targeted towards specific cells for efficient and safe targeting of tumor cells. Numerous studies have demonstrated the safety, efficiency, and specificity of nanoparticles in targeting tumor cells, making them a promising gene carrier for experimental and clinical studies. This paper aims to review the current application of nanoparticles in colorectal cancer diagnosis and treatment to provide insights for targeted therapy for colorectal cancer while also highlighting future prospects for nanoparticle development.

Non-AIDS defining cancers in HIV-infected individuals: a concise review

Non-acquired immunodeficiency syndrome (AIDS)-defining cancers (NADCs) present a growing concern in human immunodeficiency virus (HIV)-infected individuals, impacting morbidity and mortality rates. This paper synthesizes current epidemiological data and explores the multifaceted relationship between HIV infection and NADC risk. Epidemiological studies indicate a shifting landscape of cancer incidence among HIV-infected populations, with a notable rise in NADCs over recent decades. Factors such as prolonged life expectancy due to effective antiretroviral therapy (ART) and aging of the HIV-infected population contribute to this trend. Despite the overall decline in AIDS-defining cancers, NADCs have emerged as a significant cause of morbidity and mortality in HIV-infected individuals. Immunodeficiency, chronic inflammation, and oncogenic viral co-infections, such as human papillomavirus and hepatitis C virus, compound the risk of developing NADCs. Diagnostic challenges persist, with delayed detection and suboptimal management contributing to poor outcomes. Treatment modalities for NADCs in HIV-infected individuals require careful consideration, balancing cancer-directed therapy with potential interactions with ART and immune reconstitution. Prevention strategies, including cancer screening and lifestyle modifications, are crucial in mitigating the burden of NADCs in this population. As the landscape of HIV care continues to evolve, understanding the epidemiology and clinical characteristics of NADCs is imperative for optimizing clinical management and improving outcomes in HIV-infected individuals.

A positive correlation between serum lactate dehydrogenase level and in-hospital mortality in ICU sepsis patients: evidence from two large databases

BackgroundSepsis presents a significant healthcare challenge, characterized by high morbidity and mortality rates. There is a scarcity of relevant studies investigating the association between serum lactate dehydrogenase level and the prognosis of sepsis in patients from intensive care unit, with smaller sample sizes compared to other studies.MethodsA retrospective analysis was conducted utilizing data from the Second Affiliated Hospital of Guangzhou Medical University and the Medical Information Mart for Intensive Care IV (MIMIC-IV). The primary outcome was the in-hospital mortality. Multivariate Cox proportional hazards regression was adopted to assess the independent association. Receiver operator characteristic (ROC) curve was used to evaluate the predictive value.ResultsWe included a total of 2148 patients in the Guangzhou Sepsis Cohort (GZSC) database and 5830 patients in the MIMIC-IV database. In multivariate Cox proportional hazards regression, high levels of LDH are significantly associated with higher mortality (HR = 1.21, 95% CI 1.13–1.30, p < 0.001 in the GZSC database and HR = 1.19, 95% CI 1.13–1.25, p < 0.001 in the MIMIC-IV database). The ROC curves showed that the AUC of LDH was 0.663 in the GZSC database and 0.660 in the MIMIC-IV database.ConclusionsA lower lactate dehydrogenase level is associated with reduced in-hospital mortality among patients with sepsis, suggesting its potential as a valuable marker for predicting prognosis in this patient population.

064. Overview of Bacterial Patterns and Antibiotic Resistance on Cholangitis Patients at Hasan Sadikin General Hospital from January to December 2023

Background: Cholangitis is a serious infection of the bile ducts that requires prompt treatment, often with antibiotic therapy. Although antibiotic use, especially ceftriaxone and metronidazole, is vital in treatment, antibiotic resistance remains a significant challenge. Unfortunately, data on bacterial resistance patterns in cholangitis patients treated at Doctor Hasan Sadikin Hospital in Bandung is still limited. This study aims to describe the bacterial patterns and antibiotic resistance in cholangitis patients at Doctor Hasan Sadikin General Hospital. Another objective is to assess the effectiveness of ceftriaxone and metronidazole therapy in patients with moderate to severe cholangitis. Methods: This research employed a retrospective descriptive design by collecting data from the medical records of acute cholangitis patients treated at Doctor Hasan Sadikin General Hospital from January to December 2023. A total of 126 patient samples meeting the inclusion criteria were analyzed through blood cultures, and sensitivity tests were conducted against various antibiotics. Data were analyzed using SPSS software. Results: The results showed that Escherichia coli (26.3%) was the most commonly found bacterium, followed by Staphylococcus haemolyticus and Klebsiella pneumoniae (each at 13.2%). The highest resistance was observed against ampicillin (78.9%), while the most effective antibiotic was tigecycline (92.1% sensitivity). Conclusion: In conclusion, ceftriaxone and metronidazole as empiric therapy remains effective for most cholangitis patients, although resistance to certain antibiotics like ampicillin warrants attention. This study highlights the importance of regular monitoring of antibiotic resistance patterns to ensure proper treatment and reduce morbidity and mortality rates among cholangitis patients.

Acquired Hemophilia A: A Narrative Review and Management Approach in the Emicizumab Era

Acquired Hemophilia A (AHA) is a rare bleeding disorder caused by inhibitory autoantibodies to factor VIII (FVIII). The goals of treatment are two-fold, namely immunosuppressive therapy (IST) to eradicate the inhibitor and hemostatic management to control bleeding. Emicizumab, a bispecific antibody that acts as a factor VIIIa (FVIIIa) mimetic, has seen growing use in AHA following its approval for congenital hemophilia A (cHA). This review provides an overview of the epidemiology, pathophysiology, diagnosis, and treatment of AHA. Registry, trial, and case series data are assimilated and summarized with an emphasis on a standardized approach that integrates the use of emicizumab. With recent registry data suggesting the need to focus on immunosuppression-related mortality in AHA, we provide treatment recommendations in an algorithmic format that have become the standard of care at our institution. These recommendations are intended to minimize hemostatic product usage and potential toxicity related to IST, while reducing morbidity and re-hospitalization rates for bleeding. The proposed treatment algorithm, which includes key interventions by phase of therapy, can be readily implemented at centers that have rapid access to plasma FVIII activity using a one-stage assay. A case is presented to illustrate the proposed diagnostic and management considerations.

New Horizons in Nuclear Cardiology: Imaging of Peripheral Arterial Disease.

Lower extremity peripheral artery disease (PAD) is characterized by impairment of blood flow associated with arterial stenosis and frequently coexisting microvascular disease and is associated with high rates of morbidity and mortality. Current diagnostic modalities have limited accuracy in early diagnosis, risk stratification, preprocedural assessment, and evaluation of therapy and are focused on the detection of obstructive atherosclerotic disease. Early diagnosis and assessment of both large vessels and microcirculation may improve risk stratification and guide therapeutic interventions. SPECT and PET imaging have been shown to be accurate to detect changes in perfusion in preclinical models and clinical disease, and have the potential to overcome limitations of existing diagnostic modalities, while offering novel information about perfusion, metabolic, and molecular processes. This review provides a comprehensive reassessment of radiotracer-based imaging of PAD in preclinical and clinical studies, emphasizing the challenges that arise due to the complex physiology in the peripheral vasculature. We will also highlight the latest advancements, underscoring emerging artificial intelligence and big data analysis, as well as clinically relevant areas where the field could advance in the next decade.

Morphology and Function Assessment of Left Atrial Appendage in Patients With Atrial Fibrillation.

Atrial fibrillation (AF) is among the most prevalent forms of clinically significant arrhythmia, and stroke incidence is among the most serious AF-related complications, causing high rates of morbidity and mortality among affected patients. The European Society of Cardiology guidelines recommend a thromboembolic event risk assessment based on the CHA2DS2-VASC score. However, stroke also occurs in some patients with a low CHA2DS2-VASC score. Therefore, it is necessary to improve thromboembolic risk stratification in AF patients. The left atrial appendage (LAA) is considered to be the most frequent site of thrombus formation. Approximately 47% of thrombi in valvular AF and 91% of thrombi in nonvalvular AF are localized in the LAA. Therefore, identification or exclusion of LAA thrombi is critical in many clinical situations. It is essential to assess LAA morphology and function using imaging modalities (particularly echocardiography) before, during, and after interventional procedures such as AF ablation and LAA occlusion. This review article describes the anatomical, physiological, and LAA assessment in daily practice.

Machine learning in obsessive-compulsive disorder medications

Obsessive-compulsive disorder (OCD) is the fourth most common psychiatric disorder with a significant morbidity rate. Despite various treatment modalities and medications, some patients show no definitive response. The aim of this study is to classify the medications of OCD with machine learning (ML) methods and to compare the classification performances of the decision tree (DT), chi-square automatic interaction detection (CHAID) algorithm, and linear model in ML methods. This research is a descriptive analytical study based on co-word and artificial intelligence methods. The DT models were created with a target (total weight link strength). For hyperparameter optimization, the Gini index was used as the weight total link strength. The performance of the DT model was evaluated based on the prediction model. A total of 116 drugs were extracted from 6574 articles based on co-word analysis, and 56 drugs were classified as the DT's root. These drugs were categorized into six groups in the EWKM diagram. The DT was constructed using the weight.total.link index, with 7 items in Label 3 and 42 items in Label 5 serving as DT leaves. The ML analysis provided valuable insights into the efficacy of various medications such as clomipramine, duloxetine, and pindolol, as well as supplements such as folate, in the treatment of OCD. Treating concomitant diseases, namely hypothyroidism and streptococcal infection could improve the efficacy of treatment.

An Overview on Antifilarial Efficacy of Heterocyclic Motifs Encompassing Synthetic Strategies, SAR, and Commercialized Medications.

Filariasis is one of the oldest, most dangerous, debilitating, disfiguring diseases and often ignores tropical disorders. It presents with a range of clinical symptoms, a low death rate, and a high morbidity rate, which contributes to social discrimination. This condition has major effects on people's socioeconomic circumstances. This illness is carried by mosquitoes that have spread malaria. Lymphatic filariasis, caused by Wuchereria bancrofti, Brugia malayi, and Brugia timori, is a crippling illness with serious social and economic consequences. The infection persisted despite therapy with conventional antifilarial medications such as diethylcarbamazine (DEC), albendazole, and ivermectin, which are mostly microfilaricides. Current treatments (ivermectin, diethylcarbamazine, and albendazole) have limited effectiveness against adult parasites and produce side effects; therefore, innovative antifilarial medications are urgently required. Hence, macrofilaricides, embryostatic agents, and improved microfilaricides are required. The following article discusses the typical synthetic methodologies established for antifilarial activity as well as their marketed pharmaceuticals, which will help researchers, medicinal chemists, and pharmaceutical scientists to develop new and effective antifilarial therapies. This review can help to identify new lead compounds and optimize existing commercial medications to improve their therapeutic efficacy. The majority of the studies addressed in this review concern the forms of filariasis, parasite life cycle, symptoms, medications used to treat filariasis, synthetic schemes, SAR, and results from the reported research.

Rates and Risk Factors for 30-Day Morbidity After One-Stage Vertical Banded Gastroplasty Conversions: A Retrospective Analysis.

Background: The vertical banded gastroplasty (VBG) is a historic restrictive bariatric operation often requiring further surgery. In this investigation utilizing the 2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national dataset, we aim to better define the outcomes of VBG conversions.Methods: We queried the 2021 MBSAQIP dataset for patients who underwent a conversion from a VBG to Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Demographics, comorbidities, laboratory values, and additional patient factors were examined. Rates of key consequential outcome measures 30-day readmission, reoperation, reintervention, mortality, and a composite endpoint (at least 1 of the 4) were further calculated.Results: We identified 231 patients who underwent conversion from VBG to SG (n = 23), RYGB (n = 208), or other anatomy (n = 6), of which 93% of patients were female, and 22% of non-white race. The median age was 56years and body-mass index (BMI) was 43kg/m2. The most common surgical indications included weight considerations (48%), reflux (25%), anatomic causes (eg, stricture, fistula, and ulcer; 10%), and dysphagia (6.5%). Thirty-day morbidity rates included reoperation (7.8%), readmission (9.1%), reintervention (4.3%), mortality (.4%), and the composite endpoint (15%). Upon bivariate analysis, we did not identify any specific risk factor for the 30-day composite endpoint.Discussion: One-stage VBG conversions to traditional bariatric anatomy are beset with higher 30-day morbidity relative to primary procedures. Additional MBSAQIP data will be required for aggregation, to better characterize the risk factors inherent in these operations.